Endocrine Surgery at UCLA
 

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Distance Surgery Program

*If you would like to participate in our distance program, please advise us several weeks in advance of your arrival, preferably when you first contact us. It is essential that we reserve slots for the operating room and medical imaging facilities to make your experience as smooth as possible.

Overview

The UCLA Endocrine Surgery Distance Program was created to meet the demands of our increasing patient population living outside of the Los Angeles metropolitan area.

  The map below depicts hometown locations of distance program participants as of April 2014 (903 patients, 874 domestic, 30 states and territories of the US, 29 international and 17 countries).
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In order to be eligible, patients must live more than 2 hours’ drive away (without traffic) from UCLA and be in good general health.

The program’s strategy involves maximum utilization of suitable medical services in the participant’s local area, followed by a concentrated period of specialty services (imaging, consultations, pre-operative evaluation, and surgery) performed at UCLA spanning one week or less. Effective communication between our office, the patient, and referring physician is essential.

Our goal is to minimize out-of-pocket medical expenses, travel time, and overall impact on the patient’s schedule.

Most US patients who have traveled to UCLA for surgery from outside of Southern California/Nevada area did so because they have close relatives living in Los Angeles. See A word about traveling for surgery below.

If you live near a major University medical center, it is likely that an endocrine surgery specialist can be found there.

Protocol

Thorough preparatory work is required to ensure a smooth experience. Patient initiative is required for steps shaded yellow.

UCLA Distance Surgery Flow ChartAfter initial contact, our office will provide a brief checklist outlining the records and tests results necessary to establish the diagnosis. All biopsy specimens are routinely reviewed by a UCLA endocrine pathologist.

For patients with chronic diseases such as high blood pressure or diabetes, an evaluation by their primary care physician within the past 1 year is necessary. For patients with a history of heart disease, we require evaluation by a cardiologist within the past 6 months.

Certain imaging studies, most notably ultrasound and parathyroid sestamibi (a nuclear medicine test), are subject to operator variability (1, 2).

In other words, studies performed by experienced personnel are significantly more sensitive than those performed at low-volume centers.

For patients that have not yet had imaging studies, we recommend that they wait to undergo ultrasound and nuclear medicine imaging here at UCLA.

Though we will utilize positive outside results, patients with negative outside results should expect to undergo repeat imaging at UCLA.

Download/Print Protocol Flow Chart Download PDF

 

Sample schedule

A typical itinerary for a weeklong visit is shown below. Though the schedule is full, it is reasonably paced and well-coordinated. To date, no patients have found it unduly stressful. Some patients may require hospitalization beyond 1 night depending on their condition.

Sample schedule for Distance Surgery at UCLA
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Accommodations

A list of nearby hotels, some of which offer discounted rates and/or free transportation to UCLA Medical Center, can be found at:
http://www.uclahealth.org/body.cfm?id=116&oTopId=42

Additional resources

http://www.uclahealth.org/body.cfm?id=121&oTopId=42

A word about traveling for surgery

Traveling for surgery is sometimes necessary if you have an unusual condition that requires specialized medical care. Most endocrine operations do fall into this category, as high-volume centers are known to have improved patient outcomes compared to non-specialty centers for thyroid, parathyroid, and adrenal surgery (More on Outcomes in endocrine Surgery).

That said, we strongly feel that patients should have surgery while staying near family and other social supports whenever possible. In other words, stay close to home if you can. Though minimally invasive techniques have shortened recovery time from surgery by a large margin, surgery (even "minor" surgery) remains a physically and emotionally stressful event. Thus, it goes without saying that patients benefit from being near family and friends.

Specialized endocrine surgery centers exist in most major U.S. cities and tend to be clustered around universities (See Overview of Endocrine Surgery). Most people in the U.S. should not have to travel more than a few hundred miles to reach one of these centers. To find an endocrine surgery center near you, please see our listing of affiliated centers. Or please feel free to contact us by phone or email - we will be happy to help you find the resources that you seek.

Follow up

Follow up is performed remotely. Two weeks after surgery, patients have a phone consultation with Dr. Yeh. An appointment with the local referring physician is made within 1 month after surgery. We request that follow up test results be performed by the referring physician at 1 month, 3 months, and 6 months after surgery, and faxed to our office. For thyroid cancer patients, annual evaluation by the referring physician and phone consultation is required.

Please contact our office if you would like to participate in this program >>

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References

1. Perrier ND, Ituarte PH, Morita E, et al. Parathyroid surgery: separating promise from reality. J Clin Endocrinol Metab. 2002;87(3):1024-9.

2. Yeh M, Barraclough BM, Sidhu SB, Sywak MS, Delbridge LW. 200 Consecutive parathyroid ultrasound studies by a single ultrasonologist. Endocrine Practice:in press.